[CIRP Note: The Australian College
of Paediatrics (ACP) has been merged into the Royal Australasian College of
Physicians (RACP) as the Paediatrics & Child Health
Division and no longer exists as a separate entity. The RACP
had adopted this existing ACP position statement as an
interim measure but a new statement was issued in September
2002.]

THE AUSTRALIAN COLLEGE OF PAEDIATRICS

The Australian College of Paediatrics has prepared the
following statement on routine circumcision of infants and
boys to assist parents who are considering having this
procedure undertaken in their male children and for doctors
who are asked to advise on or undertake it.

ROUTINE CIRCUMCISION OF NORMAL MALE INFANTS
AND BOYS

Circumcision of males has been undertaken for religious
and cultural reasons for many thousands of years. It probably
originated as a hygiene measure in communities living in hot
and dry environments. It remains a very important ritual in
some religious/cultural groups.

During the last 50-100 years, neonatal male circumcision
became widespread in English-speaking countries. Until the
late 1960s or early 1970s, it was generally performed without
any form of anaesthesia. In Australia, the circumcision rate
has fallen very considerably in recent years and it is
estimated that currently only 10 percent of male infants are
routinely circumcised. It is now generally performed with
some form of local or general anesthesia.

There have been increasing claims of health benefits from
routine male circumcision. There are, however, also risks
associated with the procedure from infection, bleeding and
damage to the glans penis. The College has recently reviewed
evidence in relation to risks and benefits and has concluded
that it is not possible to be dogmatic on the exact
risk/benefit ratio. There are suggestions of reductions in
the risk of urinary tract infections, of local inflammatory
conditions of the penis and later cancer of the penis. It has
also been claimed that there is a reduction in the risk of
sexually transmitted disease (especially HIV) and of cancer
of the cervix in partners of circumcised males. However,
studies claiming these benefits do have methodological
problems which could influence findings and these problems
will be difficult to overcome. Therefore, at the present time
it would be wrong either to claim that there are definite
health benefits or to deny that they exist.

The possibility that routine circumcision may
contravene human rights has been raised because
circumcision is performed on a minor and is without proven
medical benefit. Whether these legal concerns are valid will
probably only be known if the matter is determined in a court
of law.

The Australasian Association of
Paediatric Surgeons has informed the College that it is
its view that routine male circumcision should not be
performed prior to the age of 6 months. It considers that
"Neonatal male circumcision has no
medical indication. It is a traumatic procedure performed
without anaesthesia to remove a normal and healthy
prepuce."

The College believes informed discussion with parents
regarding the possible health benefits of routine male
circumcision and the risks
associated with the operation are essential. Up-to-date,
unbiased written material summarising the evidence in plain
English should be widely available to parents.

If the operation is to be performed, the medical attendant
should ensure this is done by a competent operator, using
appropriate anaesthetic techniques and under medical
conditions that minimise the hazards.

In the majority of cases, parents will decide for or
against a routine male circumcision on family, social,
aesthetic and religious grounds rather than on medical ones.
In all cases the medical attendant should avoid exaggeration
of either benefits or risks of this procedure.

Date 27/5/96

Citation:

Position Statement: Routine Circumcision of Normal
Male Infants and Boys. Australian College of Paediatrics.
Parkville, Victoria: 1996.